This Is Why Ob-Gyns Tell Twin Moms to Take It Easy Sooner

Beyoncé and her baby bump brought down the house at the Grammys earlier this month, but the pregnant star is scaling back on performances as her due date draws closer. The singer, who is expecting twins with husband Jay Z, has cancelled her appearance at Coachella in April, her rep confirmed yesterday to People.

Her decision came “following the advice of her doctors to keep a less rigorous schedule in the coming months,” according to a statement released by Coachella promoter Goldenvoice and Parkwood Entertainment. Instead, Queen Bey will headline the 2018 festival.

While the move is a disappointment to her fans, it may be smart for the health and safety of the mama-to-be, and of her babies. Pregnancies carry more risks when they involve twins, says William Schweizer, MD, clinical associate professor in the Department of Obstetrics and Gynecology at NYU Langone Medical Center, and expectant mothers are often urged to take it easy a bit earlier than usual.

“The biggest concern we have with twins is preterm birth, when the babies are born before 37 weeks,” says Dr. Schweizer told Health. (Dr. Schweizer has not treated Beyoncé, and the singer has not announced when she is due.)

In fact, he says, about 60% of twins are delivered prematurely—and many have no health problems because of it. According to a 2016 study published in BMJ, 37 weeks (or 36 weeks if the babies share one placenta) is the ideal time to deliver twins in order to reduce the risk of stillbirth. Still, says Dr. Schweizer, avoiding much earlier labor is always a goal.

A woman’s risk of premature delivery is measured, in part, by changes in the length of her cervix, says Dr. Schweizer. That means that women expecting twins are monitored more closely by their doctors in the second half of their pregnancies.

“It’s not unusual for us to be really vigilant, with the mother getting exams every two to three weeks,” he says. (This is usually done via ultrasound.) When a women’s cervix measures 2.5 centimeters or less, Dr. Schweizer tells her to cut back on activities that could further increase her chances of going into labor early.

“I tell my mothers of twins that it’s okay to exercise, it’s okay to go to the gym,” he says. “But really once you’re past 24 weeks, my concerns for preterm labor increase, and I tell them to slow down a bit.”

Most women carrying twins are ready to do this anyway, he adds. “Their exercise tolerance, their weight gain, their center of gravity all change, and really make it impossible for them to continue with a very active life.”

Doctors used to recommend bed rest to women pregnant with twins—but in most cases, Dr. Schweizer says, research has not shown that it reduces preterm labor risk or improves health for the mother or babies.

Still, he recommends that women carrying twins avoid unnecessary travel and vigorous physical activity after 24 to 28 weeks. “I’m a father of twins myself, and when my wife was pregnant I asked her to work from home once she was past 24 weeks,” he says.

Avoiding travel can lower the risk of a woman going into labor early—and if it does happen, it ensures that she’s close to home, and close to her doctor. This is especially important for twin deliveries, which also have a higher-than-normal risk of complications.

In addition to preterm delivery, women carrying twins are also at higher risk for gestational diabetes and preeclampsia compared to women carrying single babies, and they’re more likely to have severe morning sickness. Getting routine prenatal care and following doctor’s orders is the best thing for mom and baby during anypregnancy, but it may be especially important when twins are on their way.